Coronavirus (COVID-19): supporting people at higher risk - qualitative research

Support Needs

Local authorities talked about the range of assistance and support that callers need. There are patterns of need: most LAs report food and medicines being their main requests, followed by befriending and financial advice or assistance. Many of these needs are connected, with callers requiring multiple assistance to support them through the crisis. For example, where people are struggling to obtain food, it often reveals wider financial concerns.

LAs report that not all callers know what support they need when they call and it can take a conversation to explore and dig out some of the support needed or to get beyond the initial single request to the wider picture of need. This was particularly noted for mental wellbeing or isolation issues, where such needs would come out through discussion, though someone had initially been calling 'only' for support with food or medicines. One LA noted the change in the quality of discussions with many callers that Covid has brought about: 'There's no "the council" and "the client", it's a more open conversation'. Some callers, though, know what they want or need and may also know what other support is available through the council. These calls could be much shorter and more direct than the more explorative calls with those who were less sure and who may have less experience of council support.

Most participants did not have detailed quantitative data to hand on requests in their area while taking part in the interview, so the below remarks come from their broad sense of caller need. However, the monitoring data we have for requests and call referrals does confirm that food and medicine are the largest set of requests LAs are dealing with. To explore the range of requests and support, these have been split into four sections below: food and medicine; financial advice; emotional support; and other needs.

Food and Medicine

Food was, and remains, the biggest demand area for the LAs we spoke to – 'food is absolutely massive'. To respond to food requests, LAs often make referrals to local food partners to provide food directly to the client or support the client in accessing food. If a need is very urgent, LAs may provide food themselves or go shopping for the client and deliver it to them. A number of LAs had developed ways of facilitating payment for those who can afford to, including hand-held card readers and supermarket till operators calling for card details once a volunteer has collected the shopping.

For people who are shielding, LAs can facilitate access to the relevant food boxes and priority delivery slots by putting in an order with the Scottish Government's shielding service via NHS Education for Scotland (NES), who then set-up delivery. Many callers contact the LA because they think they should be shielding and are therefore looking to access the same support provided for the shielding around food, particularly the priority shopping slots. Although support for those shielding is not the focus of this report, a number of issues with the food boxes were reported to us through these interviews. These have been fed back to SG colleagues responsible for policy on shielding.

Pharmacy delivery is also a frequent request, though there is some variation by authority. Some LAs use community support for such delivery or facilitate delivery by pharmacies, but others are doing this in-house. Deliveries can be arranged over the phone, but LAs might also use an email service to gather the relevant data from a caller or for repeat prescriptions. Requests include controlled substances such as methadone, which require specialist procedures, and this has included delivery via emergency services.

Food and medicine requests are highlighted as recurring by LAs. Some people will call a number of times to set up another collection of a repeat prescription, for example. Some LAs have put in place a system of call backs to those receiving food boxes or medicine repeatedly, to discuss their ongoing needs and check they are being met, but also sometimes to have challenging conversations about whether this support is still needed over time.

Some LAs are concerned about the crisis creating a reliance on LA and other support that had not been there before and how to roll back from this as support is wound up.

Financial Advice

Financial needs are often complex and can be closely related to food issues.

Local authorities are receiving calls from those struggling with loss of income, looking for advice on employment and support with benefits. Alongside this, some LAs have been dealing with calls about clients not being able to pay energy bills or requiring access to top-up cards for prepayment energy meters.

Beyond individual needs, some LAs also receive calls about grants and support available for business owners – one rural authority highlighted this as accounting for a lot of their calls.

Clients with multiple, complex needs are reported by some LAs as on the rise as the crisis continues. While others note that needs are changing over time, rather than becoming more complex: for example, people initially calling about finances, but as these needs are resolved emotional support needs have emerged.

Emotional Support

As noted above, emotional support needs tend to become apparent during calls, although callers often do not mention these at the start. LAs reported that sometimes distressed or anxious people need a befriending service, but often isolated people just want to talk to somebody. LAs are alert to the importance of this with calls sometimes lasting more than an hour, providing the person with contact and reassurance. Some callers do not currently need any support beyond that conversation, but are keen to know that should they need support in the future, it will be there. This suggests some level of anxiety within these callers, who are often older and isolated. An example of good practice comes from one rural authority that arranges regular call-backs for those that are worried about their future support needs and may be isolated/lonely. They check-in on whether their needs may have changed and provide them with some contact.

Other Needs

There are a variety of other needs and requests for support that highlight the diversity of support provided by LAs. Some callers have problem substance use, mental health or other health problems, some are living alone, some are lonely – and any combination of these.

Local authorities provide help as required, wherever reasonable. Support requested has included: delivery of baby and sanitary products; dog walking; delivery of replacement hearing aid batteries; fixing TVs and broadband; fixing front doors; toenail cutting; delivering samples to GPs; and transport to hospital appointments. These kinds of requests are usually recognised as important for people who are self-isolating and without existing support.

However, some LAs have reported unrealistic or unreasonable requests, which they are unable to fulfil. These have included very specific food requests, shopping delivery slots with alternative supermarket chains, home delivery of tobacco and alcohol, and one person asking to be helped to return from another country. These unrealistic requests were reported as very small in number.

While some of these diverse support requests may have arisen before the pandemic, interviewees reported that these requests had increased due to people's changing needs brought about by the pandemic